Developing surveillance questionnaires on underreporting of occupational injuries and illnesses – Results of cognitive testing

Background and objectives Several studies suggest that occupational injuries and illnesses are underreported. Two telephone interview questionnaires were designed to assess this issue among injured and ill workers treated in emergency departments. To improve study validity and reliability, the questionnaire development included cognitive testing. Survey methodologists conducted cognitive interviews with subjects from the target population to examine the thought processes that affect data quality. This presentation will discuss the results of that work and difficulties one may encounter in similar studies. Methods Subjects for cognitive interviews were identified from the occupational supplement to the National Electronic Injury Surveillance System (NEISS-Work) and the NEISS All Injury Program (NEISS-AIP). Subjects included employed individuals treated for either work-related or non-work related injuries. Nine interviews were completed for each questionnaire. Methodologists conducted telephone interviews using "think aloud" and concurrent probing techniques. Results Cognitive tests identified issues related to participants' ability to respond to questions about their health status, their comprehension of hypothetical scenarios, their understanding of medical billing, and their recall of interactions with emergency room staff. Conclusion The results have important implications for designing questionnaires to assess the reporting of work-related injuries and illnesses. They also provide valuable insight into improving occupational injury and illness surveillance. Among the findings are those that support the use of fact-based questions as opposed to those based on hypothetical scenarios or vignettes.